Treatment of Hypertension Flashcards
risk of end organ damage lowest at what BP?
115/75
Risk of end organ damages with every of increment of what mm Hg?
20/10
increase of systolic BP with age reflects progressive _________ of arterial circulation
stiffening
BP reading of systolic 130-139 and diastolic 80-89 indicates what stage of hypertension?
stage 1, assess 10 yr risk, if >10% risk give BP med
BP reading of systolic >140 and diastolic >90 indicates what stage of HTN?
stage 2, give 2 BP lowering meds of different classes
black patients usually respond well to treatment with _______ and _______, but have smaller BP reductions with ACE inhibitors/ARBs/and Beta blockers
calcium channel blockers, diuretics
progression of hypertension with age - cardiac output _______ and TPR ________
decreases
increases
drugs that deplete the body of sodium and reduce blood volume
diuretics
reduce peripheral vascular resistance
agents that interacts with angiotensin
relax vascular smooth muscle and dilate resistance vessels
direct vasodilators
reduce peripheral vascular resistance, inhibit cardiac function, increase venous pooling
sympatholytic agents
- thiazide diuretics inhibit _____ reabsorption in DCT
- use at low dose to lower ______ and high dose second to loop diuretics in _______
NaCl
BP, CHF
________ is the preferred thiazide diuretic bc of long half life and proven trial reduction of CVD
chlorthalidone
thiazide diuretics are most effective in what patient populations?
african americans and elderly
this drug class clinically used for:
- HTN, low dose
- CHF, higher dose
- nephrolithiasis: due to idiopathic hypercalciuria to reduce urine calcium concentration
- nephroenic diabetes insipidus: to reduce polyuria and polydipsia
thiazide diuretics
adverse effects of this drug are:
- hypokalemic metabolic alkalosis
- hyponatremia
- hyperGLUC: glycemia, lipidemia, uricemia, calcemia
- erectile dysfunction, sulfa allergy
thiazide diuretics
the only ACE inhibitor that’s an active drug?
captopril
ACE inhibitors work by inhibiting conversion of ang-1 to ang-2, which decreases _________, also increased ______ levels
peripheral vascular resistance
bradykinin
ACE inhibitors do not cause ________ because of concurrent baroreceptor resetting or vagal activation
reflex tachycardia
ACE inhibitors are most effective in what population?
young and middle aged Caucasians
- side effects of this drug include:
- dry, hacking, nonproductive cough
- hyperkalemia due to inhibited aldosterone
- angioedema and anaphylaxis
- acute renal failure
- do not use in combo with ARBs or direct renin inhibitor
- contraindicated in pregnancy
ACE inhibitors
- sartans
- more specific than ACE inhibitors, do not affect bradykinin metabolism
- more complete inhibition of angiotensin action
angiotensin receptor antagonists (ARBs)
-verapamil, diltiazem, amlodipine, felodipine, isradipine, nicardipine, nifedipine, nimodipine, nisoldipine
calcium channel blockers
calcium channel blockers work by reducing intracellular calcium, _____ arteriolar smooth muscles, leading to _______ and lower BP
relax
vasodilation
calcium channel blockers most effective in what population?
elderly and african americans (similar to thiazide effectiveness)
CCBs:
- _______ are the strongest vasodilators, but are most likely to produce reflex tachy
- _______ has the strongest cardiac effects, and don’t cause reflex tachy b/c they depress SA and AV node conduction
dihydropyridines (nifedipine)
verapamil
____ and ____ are CCBs that are contrainidicated in patients with SA or AV noe abnormalities b/c they cause bradycardia
verapamil, diltiazem
atenolol, betaxolol, bisoprolol, and metoprolol are _______ beta blockers
cardioselective
nebivolol is a cardioselective and _______ beta blocker
vasodilatory (NO production)
nadolol and propanolol and ________ beta blockers
non-cardioselective
acebutolol, penbutolol, pindolol, and carteolol are beta blockers with _________ activity
intrinsic sympathomimetic
carvedilol and labetolol are beta blockers with __________ activity
alpha and beta receptor (a1 antagonists)
beta blockers are most effective in which population?
caucasians, young hypertensives
beta blockers are combined with other antihypertensives to counteract:
- ______ caused by vasodilators
- _________ caused by thiazide and loop diuretics
reflex tachy
increased renin secretion
- beta blockers delay recovery of normoglycemia b/c it inhibits hyperglycemic responses mediated by ______
- significant risk of new onst diabetes
- abrupt cessation can lead to tachycardia, angina, MI
epinephrine
- renin inhibitor
- orally active
- dose dependent reduction of plasma renin and BP
- avoid in pregnancy
aliskiren
- blocks renin secretion
- reduction in renal sympathetic nerve activity
clonidine
- zosins
- reduce norepi induced vasoconstriction to dilate both arteries and veins
- BP falls b/c of decreased peripheral vascular resistance
- second line for BPH
- adverse hypotension, dizziniess, palpitations
alpha antagonists
clonidine, methyldopa, and guanfacine are _________ drugs
- act on alpha-2 receptors, reduce peripheral vascular resistance
- sedation and dry mouth, sudden withdrawal leads to hypertensice crissi
- methyldopa limited to pregnancy
centrally acting sympatholytics
-oral vasodilators for chronic antihypertensive treatment
hydralazine or minoxidil
- sodium nitroprusside
- diazoxide
- fenoldopam
- enalprilat
- nicardipine
- hydralazine
- act on smooth muscle to cause relaxation and reduced vascular resistance
IV vasodilators
hydralazine, monoxidil, and diazoxidde dilate _______ selectively
arteries
_______ is a balanced vasodilator of both arteries and veins
sodium nitroprusside
adverse effects of this drug:
- reflex tachy
- increased mycocardial contractions
- increased renin secretion
- fluid retention
- headaches
- flushing, palpitations
vasodilators
- the vasodilator _______ may cause a lupus like syndrome
- _______ causes hypertrichosis (rogaine)
hydralazine
minoxidil
in pregnant women, use a _______ or _______, methyldopa and hydralazine may also be used
beta blocker (labetolol)
CCB (nifedipine)
